tbuckley/cabot-search huggingface dataset:
Prescribed Opioid Dosages, Payer Type, and Self-Reported Outcomes After Surgical Procedures in Michigan, 2018-2020
Authors: Christopher J. Breuler, Christina Shabet, Lia D. Delaney, Craig S. Brown, Yen-Ling Lai, Chad M. Brummett, Mark C. Bicket, Michael J. Englesbe, Jennifer F. Waljee, Ryan A. Howard
Journal: JAMA Network Open (2023)

Importance Collaborative quality improvement (CQI) models, often supported by private payers, create hospital networks to improve health care delivery. Recently, these systems have focused on opioid stewardship; however, it is unclear whether reduction in postoperative opioid prescribing occurs uniformly across health insurance payer types. Objective To evaluate the association between insurance payer type, postoperative opioid prescription size, and patient-reported outcomes in a large statewide CQI model. Design, Setting, and Participants This retrospective cohort study used data from 70 hospitals within the Michigan Surgical Quality Collaborative clinical registry for adult patients (age ≥18 years) undergoing general, colorectal, vascular, or gynecologic surgical procedures between January 1, 2018, and December 31, 2020. Exposure Insurance type, classified as private, Medicare, or Medicaid. Main Outcomes and Measures The primary outcome was postoperative opioid prescription size in milligrams of oral morphine equivalents (OME). Secondary outcomes were patient-reported opioid consumption, refill rate, satisfaction, pain, quality of life, and regret about undergoing surgery. Results A total of 40 149 patients (22 921 [57.1%] female; mean [SD] age, 53 [17] years) underwent surgery during the study period. Within this cohort, 23 097 patients (57.5%) had private insurance, 10 667 (26.6%) had Medicare, and 6385 (15.9%) had Medicaid. Unadjusted opioid prescription size decreased for all 3 groups during the study period from 115 to 61 OME for private insurance patients, from 96 to 53 OME for Medicare patients, and from 132 to 65 OME for Medicaid patients. A total of 22 665 patients received a postoperative opioid prescription and had follow-up data for opioid consumption and refill. The rate of opioid consumption was highest among Medicaid patients throughout the study period (16.82 OME [95% CI, 12.57-21.07 OME] greater than among patients with private insurance) but increased the least over time. The odds of refill significantly decreased over time for patients with Medicaid compared with patients with private insurance (odds ratio, 0.93; 95% CI, 0.89-0.98). Adjusted refill rates for private insurance remained between 3.0% and 3.1% over the study period; adjusted refill rates among Medicare and Medicaid patients decreased from 4.7% to 3.1% and 6.5% to 3.4%, respectively, by the end of the study period. Conclusions and Relevance In this retrospective cohort study of surgical patients in Michigan from 2018 to 2020, postoperative opioid prescription size decreased across all payer types, and differences between groups narrowed over time. Although funded by private payers, the CQI model appeared to have benefitted patients with Medicare and Medicaid as well.
Minimum information and guidelines for reporting a multiplexed assay of variant effect
Authors: Melina Claussnitzer, Victoria N. Parikh, Alex H. Wagner, Jeremy A. Arbesfeld, Carol J. Bult, Helen V. Firth, Lara A. Muffley, Alex N. Nguyen Ba, Kevin Riehle, Frederick P. Roth, Daniel Tabet, Benedetta Bolognesi, Andrew M. Glazer, Alan F. Rubin
Journal: Genome biology (2024)

Multiplexed Assays of Variant Effect (MAVEs) have emerged as a powerful approach for interrogating thousands of genetic variants in a single experiment. The flexibility and widespread adoption of these techniques across diverse disciplines has led to a heterogeneous mix of data formats and descriptions, which complicates the downstream use of the resulting datasets. To address these issues and promote reproducibility and reuse of MAVE data, we define a set of minimum information standards for MAVE data and metadata and outline a controlled vocabulary aligned with established biomedical ontologies for describing these experimental designs.
Safety and Efficacy of Tenecteplase Compared With Alteplase in Patients With Large Vessel Occlusion Stroke
Authors: Fouzi Bala, Nishita Singh, Brian Buck, Ayoola Ademola, Shelagh B. Coutts, Yan Deschaintre, Houman Khosravani, Ramana Appireddy, Francois Moreau, Stephen Phillips, Gord Gubitz, Aleksander Tkach, Luciana Catanese, Dar Dowlatshahi, George Medvedev, Jennifer Mandzia, Aleksandra Pikula, Jai Jai Shankar, Heather Williams, Thalia S. Field, Alejandro Manosalva Alzate, Muzaffar Siddiqui, Atif Zafar, Oje Imoukhoude, Gary Hunter, Ibrahim Alhabli, Faysal Benali, MacKenzie Horn, Michael D. Hill, Michel Shamy, Tolulope T. Sajobi, Richard H. Swartz, Bijoy K. Menon, Mohammed Almekhlafi
Journal: JAMA Neurology (2023)

It is unknown whether intravenous thrombolysis using tenecteplase is noninferior or preferable compared with alteplase for patients with acute ischemic stroke.
Temporal Clustering of Critical Illness Events on Medical Wards
Authors: Samik Doshi, Saeha Shin, Lauren Lapointe-Shaw, Robert A. Fowler, Michael Fralick, Janice L. Kwan, Kaveh G. Shojania, Terence Tang, Fahad Razak, Amol A. Verma
Journal: JAMA Internal Medicine (2023)

Recognizing and preventing patient deterioration is important for hospital safety.
Fucose promotes intestinal stem cell-mediated intestinal epithelial development through promoting <i>Akkermansia</i> -related propanoate metabolism
Authors: Caihan Duan, Junhao Wu, Zhe Wang, Chen Tan, Lingzhi Hou, Wei Qian, Chaoqun Han, Xiaohua Hou
Journal: Gut Microbes (2023)

Intestinal stem cells (ISCs) are critical for the development and rapid turnover of intestinal epithelium. The regulatory effects of gut microbiota and their metabolites on ISCs stemness remain elusive. Fucose has been demonstrated to mediate host–microbe interactions in the intestine. However, the association between fucose, gut bacteria, and ISCs stemness remains unclear. To investigate the effects of fucose on ISCs-mediated intestinal epithelial cells (IECs) development, we administered fucose to 4-week-old mice for 4 weeks. ISCs stemness, IECs proliferation, and differentiation were examined. Variations in gut microbes and metabolism were detected using 16S rDNA sequencing and metabolomic analysis. Fucose was added to the bacterial culture medium to further study its effects on metabolism. Crypts were isolated from the mouse ileum for organoids culture in vitro to evaluate the effects of metabolites and the underlying mechanism. The results showed that fucose accelerated ISCs proliferation and secretory lineage differentiation in mice, whereas antibiotics eliminated these effects. The composition and functions of gut bacteria were altered by fucose treatment, while significant increases in Akkermansia and propanoate metabolism were noted. Propionic acid and propionate have been shown to promote organoid development. Fucose fermentation increases the production of propionic acid in Akkermansia muciniphila and enhances its ability to increase the stemness of ISCs. Moreover, ileal contents from fucose-treated mice promoted organoid development in a Gpr41/Gpr43-dependent manner. Fucose administration activates the Wnt signaling pathway in ISCs, and Wnt inhibitors suppress the effects of fucose. We conclude that fucose accelerates ISC-mediated intestinal epithelial development by promoting Akkermansia-related propanoate metabolism. These findings provide new insights into the promotion of gut homeostasis and the application potential of fucose as a prebiotic.
Commercial Health Plan and Enrollee Out-of-Pocket Spending on Accelerated Approval Products in 2019
Authors: Shelley A. Jazowski, Avi U. Vaidya, Julie M. Donohue, Stacie B. Dusetzina, Rachel E. Sachs
Journal: JAMA Internal Medicine (2023)

This cross-sectional study examines spending by health care plans and enrollees on products with accelerated approval.
Physical Activity Dose and Depression in a Cohort of Older Adults in The Irish Longitudinal Study on Ageing
Authors: Eamon Laird, Charlotte Lund Rasmussen, Rose Anne Kenny, Matthew P. Herring
Journal: JAMA Network Open (2023)

Among older adults (aged ≥50 years), depression is associated with an increased risk of physical, social, and cognitive dysfunction. Regular moderate to vigorous physical activity (MVPA) has been associated with lower odds of depression. However, the lowest dose for protection against depression and the extent to which exceeding this level conveys additional protection are unknown.To evaluate different MVPA doses, depressive symptoms, and major depression status in a large cohort of older adults with and without chronic disease.A longitudinal cohort study of the same 4016 individuals at each of 5 time points (ie, waves) from The Irish Longitudinal Study on Ageing was conducted. Data were collected from October 2009 to December 2018, and data were analyzed from June 15 to August 8, 2022.Continuous MVPA (metabolic equivalent of task [MET]-minutes per week [MET-min/wk]), 3 dose categories, and 5 dose categories measured with the International Physical Activity Questionnaire.Depressive symptoms and major depression status were measured using the short form of the Centre for Epidemiological Studies Depression scale along with the Composite International Diagnostic Interview for diagnosis of a major depressive episode during the past 12 months. Multivariable negative random-effects binomial regression models, adjusted for relevant covariates, quantified associations across time.Among the 4016 participants at each wave of the study (2205 women [54.9%]; mean [SD] age, 61.0 [8.1] years) during 10.0 years of follow-up, depression rates increased from a mean of 8.2% (95% CI, 7.4%-9.1%) to 12.2% (95% CI, 11.2%-13.2%). Bonferroni-corrected post hoc analysis indicated that participants performing 400 to less than 600 MET-min/wk had a 16% lower rate of depressive symptoms (adjusted incidence rate ratio [AIRR], 0.84; 95% CI, 0.81-0.86) and 43% lower odds of depression (adjusted odds ratio [AOR], 0.57; 95% CI, 0.49-0.66) compared with 0 MET-min/wk. Those with chronic disease performing 600 to less than 1200 MET-min/wk had an 8% (AIRR, 0.92; 95% CI, 0.86-0.98) lower rate of depressive symptoms and 44% (AOR, 0.56; 95% CI, 0.42-0.74) lower odds of depression compared with 0 MET-min/wk. Those without disease required more than 2400 MET-min/wk for similar protection for depressive symptoms (AIRR, 0.81; 95% CI, 0.73-0.90).In this cohort study of older adults, significant antidepressant benefits were noted for MVPA doses below current recommendations for overall health, although greater doses were associated with larger AIRR reductions. It may be useful for public health interventions to investigate the achievability of lower physical activity thresholds among older adults with and without chronic illness to reduce the risk of depression.
A Statewide Quality Initiative to Reduce Unnecessary Antibiotic Treatment of Asymptomatic Bacteriuria
Authors: Valerie M. Vaughn, Ashwin Gupta, Lindsay A. Petty, Anurag N. Malani, Danielle Osterholzer, Payal K. Patel, Mariam Younas, Steven J. Bernstein, Stephanie Burdick, David Ratz, Julia E. Szymczak, Elizabeth McLaughlin, Tawny Czilok, Tanima Basu, Jennifer K. Horowitz, Scott A. Flanders, Tejal N. Gandhi
Journal: JAMA Internal Medicine (2023)

Hospitalized patients with asymptomatic bacteriuria (ASB) often receive unnecessary antibiotic treatment, which increases antibiotic resistance and adverse events.To determine whether diagnostic stewardship (avoiding unnecessary urine cultures) or antibiotic stewardship (reducing unnecessary antibiotic treatment after an unnecessary culture) is associated with better outcomes in reducing antibiotic use for ASB.This 3-year, prospective quality improvement study included hospitalized general care medicine patients with a positive urine culture among 46 hospitals participating in a collaborative quality initiative, the Michigan Hospital Medicine Safety Consortium. Data were collected from July 1, 2017, through March 31, 2020, and analyzed from February to October 2022.Participation in the Michigan Hospital Medicine Safety Consortium with antibiotic and diagnostic stewardship strategies at hospital discretion.Overall improvement in ASB-related antibiotic use was estimated as change in percentage of patients treated with antibiotics who had ASB. Effect of diagnostic stewardship was estimated as change in percentage of patients with a positive urine culture who had ASB. Effect of antibiotic stewardship was estimated as change in percentage of patients with ASB who received antibiotics and antibiotic duration.Of the 14 572 patients with a positive urine culture included in the study (median [IQR] age, 75.8 [64.2-85.1] years; 70.5% female); 28.4% (n = 4134) had ASB, of whom 76.8% (n = 3175) received antibiotics. Over the study period, the percentage of patients treated with antibiotics who had ASB (overall ASB-related antibiotic use) declined from 29.1% (95% CI, 26.2%-32.2%) to 17.1% (95% CI, 14.3%-20.2%) (adjusted odds ratio [aOR], 0.94 per quarter; 95% CI, 0.92-0.96). The percentage of patients with a positive urine culture who had ASB (diagnostic stewardship metric) declined from 34.1% (95% CI, 31.0%-37.3%) to 22.5% (95% CI, 19.7%-25.6%) (aOR, 0.95 per quarter; 95% CI, 0.93-0.97). The percentage of patients with ASB who received antibiotics (antibiotic stewardship metric) remained stable, from 82.0% (95% CI, 77.7%-85.6%) to 76.3% (95% CI, 68.5%-82.6%) (aOR, 0.97 per quarter; 95% CI, 0.94-1.01), as did adjusted mean antibiotic duration, from 6.38 (95% CI, 6.00-6.78) days to 5.93 (95% CI, 5.54-6.35) days (adjusted incidence rate ratio, 0.99 per quarter; 95% CI, 0.99-1.00).This quality improvement study showed that over 3 years, ASB-related antibiotic use decreased and was associated with a decline in unnecessary urine cultures. Hospitals should prioritize reducing unnecessary urine cultures (ie, diagnostic stewardship) to reduce antibiotic treatment related to ASB.
Prevalence and Trends in Diagnosed Learning Disability Among US Children and Adolescents From 1997 to 2021
Authors: Yanmei Li, Qian Li, Juan Zheng, Xia Zeng, Tianran Shen, Qingsong Chen, Wenhan Yang
Journal: JAMA Pediatrics (2023)

This cross-sectional study uses data from the National Health Interview Survey to examine the prevalence of and trends in diagnosed learning disability among US children and adolescents from 1997 to 2021.
Effect of Maternal Egg Intake During the Early Neonatal Period and Risk of Infant Egg Allergy at 12 Months Among Breastfeeding Mothers
Authors: Ken-ichi Nagakura, Sakura Sato, Wakako Shinahara, Hiroshi Kido, Hidetoshi Fujita, Takanori Yanai, Nao Akiyama, Masaki Futamura, Hiroshi Koga, Michimasa Fujiwara, Hideo Kaneko, Hiroaki Taniguchi, Eishi Makita, Kyohei Takahashi, Noriyuki Yanagida, Motohiro Ebisawa, Mitsuyoshi Urashima
Journal: JAMA Network Open (2023)

Egg introduction in infants at age 4 to 6 months is associated with a lower risk of immunoglobulin E-mediated egg allergy (EA). However, whether their risk of EA at age 12 months is affected by maternal intake of eggs at birth is unknown.To determine the effect of maternal egg intake during the early neonatal period (0-5 days) on the development of EA in breastfed infants at age 12 months.This multicenter, single-blind (outcome data evaluators), randomized clinical trial was conducted from December 18, 2017, to May 31, 2021, at 10 medical facilities in Japan. Newborns with at least 1 of 2 parents having an allergic disease were included. Neonates whose mothers had EA or were unable to consume breast milk after the age of 2 days were excluded. Data were analyzed on an intention-to-treat basis.Newborns were randomized (1:1) to a maternal egg consumption (MEC) group, wherein the mothers consumed 1 whole egg per day during the first 5 days of the neonate's life, and a maternal egg elimination (MEE) group, wherein the mothers eliminated eggs from their diet during the same period.The primary outcome was EA at age 12 months. Egg allergy was defined as sensitization to egg white or ovomucoid plus a positive test result in an oral food challenge or an episode of obvious immediate symptoms after egg ingestion.Of the 380 newborns included (198 [52.1%] female), 367 (MEC: n = 183; MEE: n = 184) were followed up for 12 months. On days 3 and 4 after delivery, the proportions of neonates with ovalbumin and ovomucoid detection in breast milk were higher in the MEC group than in the MEE group (ovalbumin: 10.7% vs 2.0%; risk ratio [RR], 5.23; 95% CI, 1.56-17.56; ovomucoid: 11.3% vs 2.0%; RR, 5.55; 95% CI, 1.66-18.55). At age 12 months, the MEC and MEE groups did not differ significantly in EA (9.3% vs 7.6%; RR, 1.22; 95% CI, 0.62-2.40) or sensitization to egg white (62.8% vs 58.7%; RR, 1.07; 95% CI, 0.91-1.26). No adverse effects were reported.In this randomized clinical trial, EA development and sensitization to eggs were unaffected by MEC during the early neonatal period.UMIN Clinical Trials Registry: UMIN000027593.
Person-Centered Models for Cardiovascular Care: A Review of the Evidence: A Scientific Statement From the American Heart Association
Authors: Laura P. Rossi, Bradi B. Granger, Jeffrey T. Bruckel, Deborah L. Crabbe, Lucinda J. Graven, Kimberly S. Newlin, Megan M. Streur, Maya K. Vadiveloo, Benita Jeanne Walton-Moss, Bruce A. Warden, Annabelle Santos Volgman, Melissa Lydston
Journal: Circulation (2023)

Cardiovascular disease remains the leading cause of death and disability in the United States and globally. Disease burden continues to escalate despite technological advances associated with improved life expectancy and quality of life. As a result, longer life is associated with multiple chronic cardiovascular conditions. Clinical guidelines provide recommendations without considering prevalent scenarios of multimorbidity and health system complexities that affect practical adoption. The diversity of personal preferences, cultures, and lifestyles that make up one's social and environmental context is often overlooked in ongoing care planning for symptom management and health behavior support, hindering adoption and compromising patient outcomes, particularly in groups at high risk. The purpose of this scientific statement was to describe the characteristics and reported outcomes in existing person-centered care delivery models for selected cardiovascular conditions. We conducted a scoping review using Ovid MEDLINE, Embase.com, Web of Science, CINAHL Complete, Cochrane Central Register of Controlled Trials through Ovid, and ClinicalTrials.gov from 2010 to 2022. A range of study designs with a defined aim to systematically evaluate care delivery models for selected cardiovascular conditions were included. Models were selected on the basis of their stated use of evidence-based guidelines, clinical decision support tools, systematic evaluation processes, and inclusion of the patient's perspective in defining the plan of care. Findings reflected variation in methodological approach, outcome measures, and care processes used across models. Evidence to support optimal care delivery models remains limited by inconsistencies in approach, variation in reimbursement, and inability of health systems to meet the needs of patients with chronic, complex cardiovascular conditions.
Genome editing mRNA nanotherapies inhibit cervical cancer progression and regulate the immunosuppressive microenvironment for adoptive T-cell therapy
Authors: Kaijian Ling, Yin Dou, Neng Yang, Li Deng, Yanzhou Wang, Yudi Li, Leiyan Yang, Cheng Chen, Lupin Jiang, Qingchun Deng, Chenwen Li, Zhiqing Liang, Jianxiang Zhang
Journal: Journal of Controlled Release (2023)
Short-term mucosal disruption enables colibactin-producing <i>E. coli</i> to cause long-term perturbation of colonic homeostasis
Authors: Christine Harnack, Hilmar Berger, Lichao Liu, Hans-Joachim Mollenkopf, Till Strowig, Michael Sigal
Journal: Gut Microbes (2023)

Colibactin, a bacterial genotoxin produced by E. coli strains harboring the pks genomic island, induces cytopathic effects, such as DNA breaks, cell cycle arrest, and apoptosis. Patients with inflammatory bowel diseases, such as ulcerative colitis, display changes in their microbiota with the expansion of E. coli. Whether and how colibactin affects the integrity of the colonic mucosa and whether pks+ E. coli contributes to the pathogenesis of colitis is not clear. Using a gnotobiotic mouse model, we show that under homeostatic conditions, pks+ E. coli do not directly interact with the epithelium or affect colonic integrity. However, upon short-term chemical disruption of mucosal integrity, pks+ E. coli gain direct access to the epithelium, causing epithelial injury and chronic colitis, while mice colonized with an isogenic ΔclbR mutant incapable of producing colibactin show a rapid recovery. pks+ E. coli colonized mice are unable to reestablish a functional barrier. In turn, pks+ E. coli remains in direct contact with the epithelium, perpetuating the process and triggering chronic mucosal inflammation that morphologically and transcriptionally resembles human ulcerative colitis. This state is characterized by impaired epithelial differentiation and high proliferative activity, which is associated with high levels of stromal R-spondin 3. Genetic overexpression of R-spondin 3 in colon myofibroblasts is sufficient to mimic barrier disruption and expansion of E. coli. Together, our data reveal that pks+ E. coli are pathobionts that promote severe injury and initiate a proinflammatory trajectory upon contact with the colonic epithelium, resulting in a chronic impairment of tissue integrity.
Association Between the COVID-19 Pandemic and Early Childhood Development
Authors: Koryu Sato, Taiyo Fukai, Keiko K. Fujisawa, Makiko Nakamuro
Journal: JAMA Pediatrics (2023)

Although a growing number of studies have reported negative associations of the COVID-19 pandemic with academic performance among school-aged children, less is known about the pandemic's association with early childhood development.To examine the association between the COVID-19 pandemic and early childhood development.In this cohort study conducted in all accredited nursery centers in a Japanese municipality, baseline surveys of children aged 1 and 3 years (1000 and 922, respectively) were conducted between 2017 and 2019, and participants were followed up for 2 years.Children's development was compared at age 3 or 5 years between cohorts that were exposed to the pandemic during the follow-up and a cohort that was not.Children's developmental age was measured by nursery teachers using the Kinder Infant Development Scale (KIDS). Data were analyzed between December 8, 2022, and May 6, 2023.A total of 447 children (201 girls [45.0%] and 246 boys [55.0%]) aged 1 year at baseline were followed up to age 3 years, and 440 children (200 girls [45.5%] and 240 boys [54.5%]) aged 3 years at baseline were followed up to age 5 years. During the follow-up, the cohorts that were exposed to the pandemic were 4.39 months behind in development at age 5 compared with the cohort that was not (coefficient, -4.39; 95% credible interval, -7.66 to -1.27). Such a negative association was not observed in development at age 3 years (coefficient, 1.32; 95% credible interval, -0.44 to 3.01). Variations in development were greater during the pandemic than before the pandemic regardless of age. Additionally, the quality of care at nursery centers was positively associated with development at age 3 years during the pandemic (coefficient, 2.01; 95% credible interval, 0.58-3.44), while parental depression appeared to amplify the association between the pandemic and delayed development at age 5 (coefficient of interaction, -2.62; 95% credible interval, -4.80 to -0.49; P = .009).The findings of this study showed an association between exposure to the pandemic and delayed childhood development at age 5 years. Variations in development widened during the pandemic regardless of age. It is important to identify children with developmental delays associated with the pandemic and provide them with support for learning, socialization, physical and mental health, and family support.